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If you’ve ever had a dog with a sticky, smelly ear, then you’ve had a dog with an ear infection (otitis externa).
The word “otitis” refers to an inflammation of the ear, and the “externa” part is the external ear canal, the tube that sounds travel down to reach the eardrum.
Ear infections can be painful for your pet and require extra trips to the veterinarian. They might also lead to surgery.
The truth? There’s a lot of misunderstanding out there about dog ear infections.
Although this condition may seemingly occur for no reason, the vast majority of animals who have repeated ear infections are subject to underlying factors driving the infections.
Treatment often includes topical products containing antibiotics — but in an ideal world, we identify the underlying cause and tackle it to make the next bout of infection less likely.
In this expert guide to dog ear infection treatment, we’ll discuss:
- The most common underlying cause of dog ear infections
- What symptoms we usually see
- How veterinarians diagnose ear infections in a dog — and what medications they usually prescribe first
- Why it’s so important that you follow up and follow through with treatment
- How vets treat ear infections that keep coming back
- When surgery (yes, surgery) might be an option for your dog’s chronic ear infections
Part 1: What You Need to Know About Dog Ear Infections
Dog ear infections can cause yearlong — and lifelong — problems. But they are worse and more common in the summer.
Summer allergies, summer heat and swimming can be factors for those yucky ears.
Seasonal Allergies: A Big Underlying Cause of Dog Ear Infections
Many people think swimming causes ear infections, like “swimmer’s ear” in kids and people.
Water-loving dogs may be more prone to ear infections, but lots of dogs jumping into lakes and playing in oceans have perfectly normal ears. So what’s the story?
Allergic disease (atopy) is a huge underlying cause of ear infections.
Allergies are more common in spring and summer. Many dogs who never touch water have allergic otitis in the warmer months.
The allergy causes the dog’s skin to become inflamed. These dogs often have sore skin, with the infection working its way from the outside in (that is, extending from the entrance to the ear and down into the canal).
Heat and humidity can promote yeast growth in the ears, one of the most common pathogens found in dogs’ ears that causes itch, smell and irritation.
Symptoms
A normal dog’s ear canal should be clean and completely free of debris.
Some people say they’ve been cleaning their dog’s ears and getting out lots of brown debris for weeks to months. This is not normal.
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Dog ear infection symptoms:
- You smell an odor coming from your dog’s ears
- Redness
- Brown/blackish debris
- Your dog is itching their ears
For people with drop-eared dogs like Beagles, the first clue your pet has an infection is that awful smell that follows the dog from room to room.
Lifting the earflap then reveals that the skin around the ear canal is inflamed and reddened.
If the infection is well established, often the skin is thickened. If in doubt, compare one ear with the other. There may also be a discharge from the ear canal that is purulent or sometimes a thick, waxy substance.
Ear infections are painful, and the dog tilts their head down on the infected side or else shakes and scratches the ear. Some pets are in so much pain that they stop playing, lose their appetite and become “head shy.”
If you notice any of those symptoms, then it’s time to get some veterinary advice.
Diagnosis
Your vet makes a diagnosis after a physical exam of the ears.
This includes looking down inside the long L-shaped ear canal with an otoscope.
But this is tricky because often the dogs who need their ears examined are too sore and painful to allow it. In this case, the vet may suggest either:
- Sedating the animal for a thorough look without distress
- Or starting a course of anti-inflammatories and oral antibiotics to reduce swelling and soreness ahead of the next exam
When we’re trying to identify what exactly is in the ear canal, cytology is helpful. This is where the vet smears some of the discharge onto a slide and looks at it under the microscope.
This helps the vet decide if a culture is necessary and which antibiotic is most effective.
Dog Ear Infections Can Stick Around
“You must have given me the wrong ear medicine, Doc! My dog still has an ear infection.”
Veterinarians hear this a lot.
Your dog probably still has an ear infection because we didn’t find the underlying cause:
- As we said, the most common underlying cause of dog ear infections is allergic skin disease (atopic dermatitis). Many dogs, at least early in life, only show ear infections as a symptom of allergy. Ear drops alone are not going to control these dogs — we must address atopy in a systemic approach.
- Year-round ear problems may also be a bad food reaction. If dogs are showing up in January with bad ears, a food trial is definitely indicated.
Treatment
Topical treatment in the ears, if done correctly, certainly helps.
However, a heavy discharge in the ear acts as a barrier to the penetration of a topical medication. For this reason, most vets prescribe both an ear cleaner and a medication for the ears.
Treatment steps:
- Ear cleaning and de-bulking the pus or wax is an important step, after which the vet may use those topical medicated drops.
- If the infection is severe, then sedation to flush the ear clean is a great idea, and the pet may also need oral antibiotics.
- If the pet suffers from recurring infections, it’s appropriate to investigate any underlying causes. This may include putting the animal on a hypoallergenic diet, blood tests checking thyroid function and investigations into possible allergies.
It’s important to understand that ears are just an extension of the skin. Strangely, skin disease can be strictly confined to the ear. If excessive hair is a contributing factor, learning how to pluck hair or having a groomer do it is important.
Know that not all ear cleaners are the same. Get advice from your vet before spending the same amount of money on a product from a pet store. Some over-the-counter products may be appropriate for your dog’s problem, but get that professional advice first.
Many dogs need systemic medications or allergy testing along with ear medication. Catching these problems early is the key.
This video gives more dog ear infection treatment advice from a veterinarian:
Follow Up and Follow Through
Many people will leave the vet’s office having watched the vet clean and medicate the ears and think they know what to do. But often they don’t.
A great idea is to ask the technician to spend extra time to make sure you understand what home care is needed.
Dogs with chronic ear infections are difficult to treat. Newer products on the market require only once-a-week or even less frequent treatment. Often, a vet or vet tech can do this, so the frustration between human and beloved canine doesn’t worsen.
Rechecks are extremely important, although many people don’t return. But make sure your vet rechecks the ears after the 2-week dog ear infection treatment period.
Perhaps you think that because the itch is gone and the smell is better, everything is OK. But if your vet finds lots of deep debris, redness and inflammation in that ear canal on an otoscopic exam, the problem has not been solved, and the symptoms will return.
Following up on first or early infections can save you a lot of money down the line.
A festering, underlying ear infection will:
- Come back with a fury
- Be more difficult to treat
- Be more expensive to treat
- Cause chronic changes in the ear that may lead to continual treatment failure
Follow advice and seek early treatment. With ears, an ounce of prevention is truly worth it.
Part 2: How We Treat Recurrent Dog Ear Infections
Does your dog get regular ear infections?
You’re not alone — it’s estimated up to 20% of all dogs will suffer at least one ear infection during their lifetime.
Some unlucky dogs are martyrs to their ears with infection after infection. But why is this, and what can you do about it?
A One-Off Ear Infection
Your dog scratches and scratches their ear, keeping you awake all night. You lift the ear flap to discover an angry red ear and a smelly discharge. You hotfoot it to the vet, who examines the ear.
The vet will look for trigger factors that caused the problem, such as:
- Swimming: Water in the ear canal softens the skin, making it more vulnerable to infection.
- Anatomical factors: Hairy ear canals, excessive wax production or heavy, pendulous ears can decrease air circulation.
- A foreign body: The classic is grass stuck in the ear canal, causing pain and irritation.
- Ear mites: A common parasite that likes to set up home in the ear canal and cause intense itchiness.
- General itchiness: A dog with parasites or allergies will be itchy. Scratching the ear could damage it and set up infection.
If this is the dog’s first ear infection and there is no obvious cause (such as grass in the ear canal or a colony of ear mites), then the dog ear infection treatment is straightforward. We discussed it above in Part 1 of this article.
Fingers crossed, the dog’s ear infection clears up and never comes back. But what if it does?
Treating a Recurrent Dog Ear Infection
If the ear infection comes back relatively quickly, the vet may need to take things to the next level and investigate.
This involves any or all of the following:
Culture and Sensitivity
The ear discharge is swabbed and sent for culture and sensitivity. This tells the vet exactly which bugs are present and which is the best antibiotic at killing them.
This makes for targeted treatment that stands an excellent chance of success.
Cytology
Here, the vet rolls a cotton swab against the skin of the ear canal, then presses the sample onto a slide.
This is then stained and examined under the microscope. This gives valuable information about the cell types (inflammatory or infectious), bacteria types (rods or cocci) or the presence of yeasts or parasites such as ear mites.
Again, this helps to target treatment.
Examine Under Sedation
The ear may be too painful to properly examine with the dog conscious. Sedation allows the vet to check the deepest part of the ear canal and give the ear a thorough clean.
Long Course of Treatment
Once the right drugs are hit upon, a long course of treatment gives the best chance of totally clearing the problem.
Repeat Culture
At the end of treatment, the vet will check if the culture is now negative.
But what if you do all this — and then the ear flares up again?
Regular Ear Infections
Sometimes we follow all the right protocols and yet the dog still gets repeated ear infections.
This is a strong indication that there’s something unusual about that ear. There has to be a deeper underlying reason why the ear is poor at fighting off infection.
One possible explanation? A food allergy.
For some bizarre reason, dogs who have food allergy often get recurrent ear infections. The answer here is a food trial and putting the dog on a hypoallergenic diet.
The theory is that when the allergen that triggers the allergic reaction is removed from the diet, then the trigger for the ear infection is removed.
It’s great news when this is diagnosed because controlling what the dog eats is very close to “curing” the ear infections in the dog.
But what if the dog goes on a dietary trial — and still gets ear infections?
The Dog Still Gets Flare-Ups
By this stage, your vet may well be thinking of referring the dog to a specialist.
But there’s one last throw of the dice:
- Repeat culture: Is infection present, or is this a sterile form of inflammation that isn’t linked to infection?
- Cytology: Again, this is to see if the ear is free from bacteria.
If the sore ear is sterile (no bacteria present), then the problem could be with the dog’s overreactive immune system.
The next step is to suppress the immune system either with steroid ear drops or with medications that suppress inflammation.
- Of these, the most economical is prednisolone.
- However, there are several much more sophisticated (but more expensive) options with fewer side effects.
By this stage, a good percentage of problem ear infections are under control. But what if they’re not?
That’s what we’ll discuss in the next section of this expert guide…
Part 3: When an Ear Infection Turns Into Ear Surgery
When we’ve explored all other treatment options, and the dog fails to respond and is in constant discomfort, then surgery is the best option.
There are various operations, of which the most common is a total ear canal ablation (TECA). This is literally removing the ear canal (the dog will be deaf on that side), but in so doing the cause of the inflammation and pain is removed.
Yes, it is a nuclear option, but it definitely improves quality of life for those poor dogs plagued with a constant earache.
When Surgery Becomes an Option
When all of the usual treatments fail, the only option may be surgery.
- By then, the ear canal is a swollen, painful, smelly mess.
- The lining is so thickened that medications simply do not reach the source of the problem — the very bottom of the ear canal.
This is critical to understand. If the ear canal is too thick, you can pour all the medications in the world in there, but it is a waste of money. They physically cannot go through.
Surgery is then recommended. There are various options:
In many advanced or terminal cases, the most appropriate surgery is a total ear canal ablation (TECA). Again, this means exactly what it says: The entire ear canal is removed.
In addition, this is the only surgery that allows a lateral bulla osteotomy — meaning that the TECA allows cleaning up the bulla.
And what’s a bulla? The bulla is a “bony bubble” at the bottom of the ear canal, and it is part of the skull. Once the eardrum ruptures, pus and debris accumulate inside the bulla. The only option to clean it up is along with a TECA.
Failing to clean up the bulla leads to failure of the surgery and a nasty, delayed infection.
Prognosis With Total Ear Canal Ablation Surgery
As invasive as the TECA sounds, results are typically excellent.
The prognosis is also better than with other, less invasive surgery options.
Only the TECA takes care of the entire problem — ear canal and bulla. When the surgery is over, there is no ear canal. Therefore, you will never have to use another ear medication. There isn’t even an opening to put the meds in!
The next question is: Who will do the surgery?
As there are undeniably possible complications (deafness is usually not one of them), you want an experienced veterinarian or veterinary surgeon to perform surgery on your pet. Although complications do occur even with the best board-certified surgeons, choose someone who does ear surgery regularly.
Final Thoughts
The take-home message here is that if your dog gets regular ear infections, work with your vet to get to the bottom of the problem.
Dog ear infections are frustrating, but they’re also surprisingly complex and can be difficult to treat, so your dog’s treatment will take time and patience.
References
- Woody & Fox. “Otitis externa — seeing past the signs to discover the underlying cause.” Vet Med Small Anim Clin, 87: 616.
- Wilson. “A practitioner’s approach to complete ear care.” (1985). Dermatology Reports, 4.
This pet health content was written by veterinarians, Dr. Debora Lichtenberg, VMD; Dr. Pippa Elliott, BVMS, MRCVS; and Dr. Phil Zeltzman, DVM, DACVS, CVJ. It was reviewed for accuracy by Dr. Elliott and was last updated May 5, 2019. 
